Thirty-year Trend of Non-rheumatic Valvular Heart Disease: A Comparison of Pakistan with South Asia and Global Scenario
Article Sidebar
Main Article Content
Abstract
Background: Improved prophylaxis has shifted valvular heart disease (VHD) from rheumatic to non-rheumatic causes globally, with rheumatic VHD nearly eradicated in high-income countries. However, non-rheumatic VHD remains a major health issue in low-to-middle-income countries like those in South Asia. This study examines non-rheumatic VHD trends in Pakistan compared to South Asia and global figures.
Objective: To evaluate non-rheumatic VHD trends in Pakistan from 1990 to 2019 using Global Burden of Disease (GBD) data.
Methods: The study extracted data on prevalence, deaths, disability-adjusted life years (DALYs), and age-standardized death rate (ASDR) from the GBD study. An ecological design analyzed data using Excel and R-Studio. Poisson regression assessed the 30-year ASDR trend at global, South Asian, and national levels, calculating percentage changes with incidence rate ratios (IRR) and 95% confidence intervals.
Results: From 1990 to 2019, Pakistan's non-rheumatic VHD prevalence increased by 14.1% (6.4 to 7.3 per 100,000), and ASDR rose by 12.9% (1.32 to 1.49), with an IRR of 1.102 (95% CI: 1.002-1.198). Global ASDR slightly decreased (IRR: 0.997, 95% CI: 0.971-1.024), and South Asia’s IRR was 0.996 (95% CI: 0.959-1.034). Deaths in Pakistan rose by 1.1% (0.59 to 0.60 per 100,000), and DALYs increased by 17% (14.1 to 16.5 per 100,000), with significant rises in Sindh (30.3%), Baluchistan (23.7%), and Azad Jammu & Kashmir (23.9%).
Conclusion: GBD data show a significant increase in non-rheumatic VHD burden in Pakistan over 30 years, necessitating policy and interventions to address this growing health issue.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Remenyi B, ElGuindy A, Smith Jr SC, Yacoub M, Holmes Jr DR. Valvular Aspects of Rheumatic Heart Disease. Lancet. 2016;387(10025):1335-46.
Khan MN, Ahmed B, Majeed H, Tareen I, Hassan M, Shehzad M, et al. Thirty Years Trend of Rheumatic Heart Diseases, Pakistan Chapter: Insights from the Global Burden of Disease Study. Pak Heart J. 2022;55(3):231-5.
Jang SY, Ju EY, Seo SR, Choi JY, Park SJ, Kim DK, et al. Changes in the Etiology of Valvular Heart Disease in the Rapidly Aging Korean Population. Int J Cardiol. 2014;174(2):355-9.
Watkins DA, Johnson CO, Colquhoun SM, Karthikeyan G, Beaton A, Bukhman G, et al. Global, Regional, and National Burden of Rheumatic Heart Disease, 1990–2015. N Engl J Med. 2017;377(8):713-22.
Raheem A, Ahmed S, Kakar AW, Majeed H, Tareen I, Tariq K, et al. Burden of Cardiovascular Diseases in South Asian Region from 1990 to 2019: Findings from the Global Burden of Disease Study. Pak Heart J. 2022;55(1):15-21.
Chen J, Li W, Xiang M. Burden of Valvular Heart Disease, 1990-2017: Results from the Global Burden of Disease Study 2017. J Glob Health. 2020;10(2).
Sliwa K, Carrington MJ, Klug E, Opie L, Lee G, Ball J, et al. Predisposing Factors and Incidence of Newly Diagnosed Atrial Fibrillation in an Urban African Community: Insights from the Heart of Soweto Study. Heart. 2010;96(23):1878-82.
Ananth CV, Hansen AV, Williams MA, Nybo Andersen AM. Cardiovascular Disease in Relation to Placental Abruption: A Population‐Based Cohort Study from Denmark. Paediatr Perinat Epidemiol. 2017;31(3):209-18.
Bainey KR, Gupta M, Ali I, Bangalore S, Chiu M, Kaila K, et al. The Burden of Atherosclerotic Cardiovascular Disease in South Asians Residing in Canada: A Reflection from the South Asian Heart Alliance. CJC Open. 2019;1(6):271-81.
Joseph P, Leong D, McKee M, Anand SS, Schwalm JD, Teo K, et al. Reducing the Global Burden of Cardiovascular Disease, Part 1: The Epidemiology and Risk Factors. Circ Res. 2017;121(6):677-94.
Volgman AS, Palaniappan LS, Aggarwal NT, Gupta M, Khandelwal A, Krishnan AV, et al. Atherosclerotic Cardiovascular Disease in South Asians in the United States: Epidemiology, Risk Factors, and Treatments: A Scientific Statement from the American Heart Association. Circulation. 2018;138(1).
Tillin T, Hughes AD, Mayet J, Whincup P, Sattar N, Forouhi NG, et al. The Relationship Between Metabolic Risk Factors and Incident Cardiovascular Disease in Europeans, South Asians, and African Caribbeans: SABRE (Southall and Brent Revisited)—A Prospective Population-Based Study. J Am Coll Cardiol. 2013;61(17):1777-86.
Palaniappan L, Garg A, Enas E, Lewis H, Bari S, Gulati M, et al. South Asian Cardiovascular Disease & Cancer Risk: Genetics & Pathophysiology. J Community Health. 2018;43(6):1100-14.
Government of Pakistan. Final Results of Census-2017: Table-5 - Population by Selected Age Group, Sex and Rural/Urban. Pakistan Bureau of Statistics. Available from: https://www.pbs.gov.pk/content/final-results-census-2017-0
Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019 (GBD 2019) Results. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2020. Available from: http://ghdx.healthdata.org/gbd-results-tool
Nejad M, Ahmadi N, Mohammadi E, Shabani M, Sherafati A, Aryannejad A, et al. Global and Regional Burden and Quality of Care of Non-Rheumatic Valvular Heart Diseases: A Systematic Analysis of Global Burden of Disease 1990–2017. Int J Qual Health Care. 2022;34(2)
Kurji Z, Premani ZS, Mithani Y. Analysis of the Health Care System of Pakistan: Lessons Learnt and Way Forward. J Ayub Med Coll Abbottabad. 2016;28(3):601-4.
Wang YT, Tao J, Maimaiti A, Adi D, Yang YN, Li XM, et al. Prevalence of Valvular Heart Diseases and Associated Risk Factors in Han, Uygur and Kazak Population in Xinjiang, China. PLoS One. 2017;12(3).
Barolia R, Sayani AH. Risk Factors of Cardiovascular Disease and Its Recommendations in Pakistani Context. JPMA. J Pak Med Assoc. 2017;67(11):1723.
Moore M, Chen J, Mallow PJ, Rizzo JA. The Direct Healthcare Burden of Valvular Heart Disease: Evidence from US National Survey Data. Clinicoecon Outcomes Res. 2016;8:613.
Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of Valvular Heart Diseases: A Population-Based Study. Lancet. 2006;368(9540):1005-11.
Towler DA. Molecular and Cellular Aspects of Calcific Aortic Valve Disease. Circ Res. 2013;113(2):198-208.
Akat K, Borggrefe M, Kaden JJ. Aortic Valve Calcification: Basic Science to Clinical Practice. Heart. 2009;95(8):616-23.
Writing Committee Members, Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin III JP, et al. 2020 ACC/AHA Guideline for the Management of Patients with Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2021;77(4).
Afshin A, Sur PJ, Fay KA, Cornaby L, Ferrara G, Salama JS, et al. Health Effects of Dietary Risks in 195 Countries, 1990–2017: A Systematic Analysis for the Global Burden of Disease Study 2017. Lancet. 2019;393(10184):1958-72.